In a Vancouver experiment over the past year and a half, seven paralyzed patients played computer games at home while electrodes in a wrist cuff sent electrical currents to paralyzed muscles so they could contract, allowing users to grasp and move a joystick.

The wrist stimulator is controlled by users when they click their teeth to trigger hand opening or closing. Every tooth click generates a vibration in the jaw and temporal bones that is detected by a sensor in an earpiece, similar to a Bluetooth device.

While electrical stimulation is now broadly used in rehab of such patients, previous work has shown that electrical stimulation triggered by voluntary (controlled) movements produces better results than when non-triggered stimulation is used.

The technologically advanced exercise therapy trial was funded by a $360,000 grant from the Rick Hansen Institute.

The study utilized what is called a ReJoyce workstation, a system invented by University of Alberta biomedical engineers Jan Kowalczewski and Arthur Prochazka. It helps build function and strength in the hands of those who have lost both because of stroke or spinal cord injuries.

In Montreal and Toronto, the same experiments using the ReJoyce (Rehabilitation Joystick for Computer Exercise) were repeated in another 10 study participants, all of whom still had intact brain cognition but a spinal cord injury resulting in limb paralysis.

The purpose of the study was to evaluate improvements in hand function and to be able to predict how often the therapy would have to be used to attain benefits, so training once a week was compared with training five times a week.

Study results are now being analyzed and will eventually be published in a medical journal. But based on several previous studies and analysis of the current study so far, researchers expect the benefits of ReJoyce therapy will be confirmed as a rehabilitation model for upper limb strength and dexterity; that would give those with paralysis more independence.

Worthwhile effort

Tania Lam, a University of B.C. researcher who led the Vancouver arm of the study, said it involved tremendous effort on the part of study coordinators and participants, but it was worth it.

“This was a great study to be involved in. The participants who volunteered their time to participate in this study were very dedicated and committed to the research, allowing us into their lives and homes to install the ReJoyce workstation and patiently working with us through the demands of the study — multiple testing sessions, weekly training sessions for two months and followup testing over 12 months after the training ended,” she said.

“We [saw] from our own [preliminary] data in Vancouver that participants really benefited from this type of training, achieving abilities with their hand function that they had not been able to do [since their injury],” added Lam, an associate professor of kinesiology who is affiliated with the International Collaboration on Repair Discoveries (ICORD).

“In consideration of the demands on people’s everyday lives, if this type of therapy is going to be widely used, it’s important to understand whether it ends up needing to be an intensive, daily commitment or whether once per week could be adequate,” she said.

Since users may not have any hand function when they start to use the technology, they may require a caregiver to put the wristlet on for them.

“Tetraplegic people can do more with their hands, arms and teeth than you might imagine,” Prochazka said.

“The earpiece has a small radio transmitter that sends a packet of coded information to a receiver in the stimulator, which is the size of an iPod mini and is located within the wristlet. In some cases, a caregiver puts it on for them. In other cases, they manage themselves,” said Prochazka, who coordinated the study and has a vested interest in ReJoyce since he is involved in a private company called Hometelemed that is already offering in-home rehab therapy using the ReJoyce system.

ReJoyce exercises are meant to help patients perform basic functions of everyday life. If the rehabilitation activity is proven to help improve hand function, then patients could again do things such as open doors, turn handles, pick up items and move them.

The ReJoyce workstation consists of a laptop computer loaded with at least eight games requiring numerous hand actions on the joystick, such as grasping, gripping, squeezing, pinching and lifting.

Although Nintendo’s Wii games are sometimes used for physical or occupational therapy, Prochazka said they aren’t intended to be used as clinical devices. They may be beneficial for whole limb range of motion, but not so much for fine motor control, strength and dexterity.

Tele-rehabilitation

Throughout the one-hour sessions over eight weeks, trial participants were being supervised and watched by webcams over the Internet. Study researchers in remote locations could observe and interact with the study subjects in what’s been called the world’s first multi-centre trial of in-home tele-rehabilitation.

The tele-supervisor’s role was to watch a webcam image of the patient and remotely control the games and sensors. At the same time, they downloaded performance data generated by the hand function test software.

Prochazka said the ReJoyce hand exercise workstations have gone through several iterations for fine tuning and are now being manufactured for sale. Up to now, it has largely been a research tool in North America, but a rehab centre in Edmonton — Glenrose Rehabilitation Hospital — was the first to start using it on patients. It has also been commercialized for sale, at $8,000, in some places around the world.

Hometelemed, the private company in which Prochazka and Kowalczewski both have a vested interest, has been set up to provide supervised ReJoyce rehab over the Internet to users in their homes.

But unless patients are covered for such treatment by extended health insurance plans, the daily therapy may cost about $2,300 over six weeks.

Rod Cebuliak was one of the first patients to use ReJoyce when he took part in a study about four years ago using an early prototype. The Edmonton resident became a quadriplegic in 2006 when he broke his neck in an extremely rare event — and cruel twist of fate — while doing nothing more than bending over.

“My hands and fingers are very badly atrophied so that’s the primary reason I was motivated to be a guinea pig with this kind of research, to help myself and others,” Cebuliak said.

“The ReJoyce system certainly helped me try to do more things and improve my fine motor function and strength. It’s the kind of system anyone can use and it’s not boring, redundant or repetitive because of the game format,” he said.

2:41 p.m.: Lululemon CEO Christine Day joins the relay on West Broadway from Angus Bakery to 3466 W. Broadway.

Source: Rick Hansen Foundation

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